Politics and the Poor

Alec MacGillis has a good piece in the American Prospect on the difficulty politicians have talking about poverty. It reminds me of a conversation I had recently with a smart social policy advocate on this topic, and have been meaning to write up. But before I get into it, I'll add that this is a bit of a delicate topic, and ask that people take me at my word when I say I'm not criticizing anyone, but instead pointing out a structural imbalance.

He argued that it was little surprise that the public option had come to dominate the health-care debate. The rest of the bill's primary selling points are about helping the poor, and that doesn't sell in American politics, not even among the left.

Look at the large, member-driven organizations, he argued. Groups such as MoveOn.org or True Majority. They're all in favor of efforts to address poverty, but it's not the core item on the agenda, and that's because their constituencies fundamentally aren't poor. Because of that, they're a lot more aggressive on policies that appeal to their membership's political beliefs — the public option being a good example — than policies that directly help the poor, such as whether the subsidies reach 300 percent or 400 percent of poverty, or whether Medicaid expands to 133 percent or 150 percent of the poverty line.

Conversely, the groups that spend a lot of time on poverty — think the Center for Budget and Policy Priorities, or Families USA — aren't member-driven. They're advocacy organizations, they tend to rely on foundation grants or endowments, and they tend to play a bit more of an inside Washington game, because they don't have funding sources or a membership structure that lends itself to grass-roots pressure. Foundations, after all, give a lot of money for research, but not that much money for attack ads. And people living just above the poverty line don't tend to send in $100 when you tell them subsidies in a bill are about to be cut, even though those subsidies will hurt them a lot more than the public option will help most of MoveOn.org's members.

Put another way, the basic problem is that poor people, by virtue of being poor, can't donate a lot of money to popularize their concerns, and are fairly marginalized from the political process in general. The result isn't that those concerns are entirely ignored in Congress, as many of these institutions are very effective, and many legislators take this stuff very seriously. I agree with everything that Bob Greenstein, CBPP's director, says here, for instance. But it is that there's little infrastructure for pushing them into the national conversation.

The effects of this can be a bit weird: The health-care bill, for instance, spends pretty much all of its money on the poor, and its structure is primarily designed to increase coverage among low-income Americans. But pollsters have advised Democrats not to talk about that, and so they don't. Instead, they talk about how insurers are evil, or the public option is good, because those issues are more resonant both among the broader electorate and the liberal base. When people like, well, me, criticize Obama for neglecting the moral case for health-care reform, it's not because he forgot about it.

And because it's Ted Kennedy day around here, it's also worth saying that Kennedy was one of the few Democrats who could speak about this stuff effectively, as you can read in this speech.

This is why campaign finance reform is still so important. The whole point of democracy is to create a system where everyone has equal input into collective policies. Instead we have a system where each person has one vote, but a donation of $100 is worth much more to a politician than a vote. So instead of a democracy, we have a diffused plutocracy. No surprise that in a system where donations outweigh votes, the influence of the non-donors is insignificant. But were we to ban all donations in favor of public financing, the influence of the poor voters would go up quite a bit. I really don't understand how people can argue that the right to buy a politician (sorry, donate to) outweighs the fundamental principle of democracy -- that each person should have the exact same unit of influence in their government.

Ezra, I don't think it's an either/or situation. I care a lot about covering low-income Americans --- as you and Alec rightly note, it's the whole point of health-care reform --- but I'm concerned that if the bill doesn't adequately control costs, the gains it provides to low-income Americans will erode over time. If the cost of health care continues to increase and deficits continue to rise, then sooner or later "entitlement" programs --- including subsidized health insurance for low-income families --- will inevitably be targeted for cuts. We need a bill that not only covers the low-income population today, but also is structured in a way that the program is sustainable.

That's why the White Houses tradeoffs w/ big pharma and the insurance lobby rankle, and ditto the upcoming loss of the public option. Much of the cost of those compromises will ultimately fall on the backs of the poor.

The other thing that makes discussing poverty is that a large percentage of the poor, especially those on the edge of the lower-middle/poor boundary, don't self-identify as poor and oppose programs designed to make them better off.

I agree with lboros. We have to reduce costs, and if we do that everybody benefits. A happy by-product of the plan is subsidized insurance for the poor. But the main goal of universal coverage is to dispense with the costly bureaucracy that now exists to deal with the uninsured.

It's one thing to suggest the poor can't donate to campaigns "by virtue of being poor", it's quite another thing to suggest they don't participate politically "by virtue of being poor". If the poor simply voted at the same rate as the other income groups, we'd have a very, very different politics in America and there wouldn't even be a serious debate over universal health care.

1) You forget the labor movement, which is both the strongest institutional backer of health care reform (including a robust public option) and the strongest movement fighting poverty (such as by raising the minimum wage and organizing low wage workers).

2) As a progressive with policy wonk friends, I am open to hearing arguments that the public option is not the end-call, be-all of health care reform. I think a substantial amount of the focus on the public option, at the expense of other elements of the reform proposal, is simply that that the "public option" is a simple, easy to comprehend phrase. Those who want more focus on other elements need to come up with some simple, understandable (for non-policy wonks) phrases to describe it. Who knows what an "exchange" is? All I have heard people say is that it will be like Orbitz, which is not an exciting way to talk about it.

Is healthcare without the public option is the same as the "Massachusetts plan" (i.e. was there a public option in Mass?)? I think liberals, if not progressives, have been generally positive about what has happened there; perhaps that is an entry-point for talking about the other elements of reform.